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Oklahoma Health Care Authority
CAHPS® Adult Health Survey
for SoonerCare Choice
Executive Summary and
Technical Specifications
Report for Fiscal Year 2010
Report Submitted May 2010
Submitted by:
APS Healthcare
4545 North Lincoln Boulevard
Suite 24
Oklahoma City, Oklahoma 73105
(405) 556-9700
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 2
CAHPS® Adult Health Survey for SoonerCare Choice
Executive Summary
The Oklahoma Health Care Authority (OHCA) is the state agency responsible
for administering Medicaid. SoonerCare Choice, the managed care component of
Oklahoma Medicaid, operated under a partially capitated case management system
during the first half of the state fiscal year (SFY) 2009. A patient-centered medical
home model was implemented January 1, 2009. In order to evaluate service
satisfaction, the OHCA contracted with APS Healthcare to survey adult members
enrolled in SoonerCare Choice between December 1, 2008, and November 30, 2009.
The OHCA has administered CAHPS (Consumer Assessment of Healthcare
Providers Systems) surveys to measure consumer satisfaction in the Medicaid
population since 1996.
Comparing the 2008 survey and the 2010 survey, results indicated fairly high
levels of satisfaction holding steady across an array of eight quality measures. The
overall picture drawn by the CAHPS data is one of high and rising satisfaction with
several different aspects of health care received from SoonerCare providers, and also
customer services provided directly by SoonerCare. Positive trends were seen in
ratings of health care, personal physicians, specialists, and the health plan, and also in
composite measures of getting care quickly, provider communication, getting needed
care, and customer service. One increase was statistically significant; respondents
gave higher ratings on how often they were able to get care quickly.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 3
CAHPS® Adult Health Survey for SoonerCare Choice
Technical Specifications
Consumer satisfaction surveys are an important source of information to
consumers, purchasers of health care, health plans and program administrators. By
responding to satisfaction surveys, individuals provide valuable information regarding
access to care, use of services, and satisfaction with the care they have received. To
survey the general population of managed care members about their overall experience
with their health plan, the Oklahoma Health Care Authority (OHCA) has administered
Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys to
SoonerCare members since 1996. CAHPS questionnaires, administration protocol and
survey analysis were developed by Harvard, RAND and the Research Triangle Institute.
The health care community has accepted these methods in producing consumer
satisfaction measures that may be compared across health plans and health service
delivery types.
In order to evaluate service satisfaction, the OHCA contracted with APS
Healthcare (APS) to survey the members enrolled in SoonerCare Choice between
December 1, 2008, and November 30, 2009. This technical report includes information
on the survey methodology, findings, and summary information on the respondents’
satisfaction with health plan services they received.
Method
The Adult CAHPS Health Plan Survey 4.0 questionnaire (shown in Appendix A)
was administered by The Myers Group (TMG) between December 16, 2009, and April 1,
2010. The questionnaire addressed several aspects of health plan performance, including:
• Rating of personal doctors, specialists, health care received, and health plan
• Receiving care without long waits
• Communication with clinicians
• Health plan information and customer service
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 4
• Getting needed care
Sampling
Because it is not feasible to survey the entire SoonerCare Choice population,
TMG used recognized sampling techniques to obtain information from a limited number
of members. This information is used to estimate the consumer satisfaction of the
SoonerCare Choice population as a whole.
Sampling for this survey followed CAHPS 4.0 protocols with one exception:
APS limited the sample to members with at least one paid claim from a SoonerCare
Choice provider. APS provided TMG with a list of eligible members for sample
selection. Each member included in the eligibility list met the following criteria:
• 18 years of age or older as of November 30, 2009;
• Enrolled in the SoonerCare Choice program as of November 30, 2009; and
• Continuously enrolled in SoonerCare Choice for 12 months between December 1,
2008, and November 30, 2009. (Continuous enrollment was defined as having no
more than one 45-day break in enrollment during the year.)
In accordance with CAHPS recommendations and to reduce the burden on
respondents, TMG randomly selected only one member from a household for the sample.
The CAHPS Survey and Reporting Kit 4.0 standards indicate that a minimum of 300
completed surveys are needed for a valid administration. The total number of members
eligible for the survey was 44,772; TMG selected a random sample of 1,688 members.
Data Collection
The CAHPS survey methodology allowed data to be collected by mail, telephone
interview, or a combination of mail and telephone. The OHCA and APS agreed to
conduct these surveys using mail and incorporated telephone interviewing only when the
targeted response rate was not received. The survey process had outreach interventions
that included mailings of the survey packet, reminder postcards and phone follow-up with
interviewers.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 5
After the sample was selected, address lists were processed using the U.S. Postal
Service’s CASS Certified ZIP + 4 Coding Software, which verified the zip code for each
address. Each packet included a questionnaire and a letter that explained the purpose and
the importance of the survey. To encourage participation, the packet also contained a
postage-paid business reply envelope. Reminder postcards served to thank individuals
who had responded to the survey and to remind others to complete their questionnaires.
Members selected for the sample who did not respond to the first survey and/or postcard
mailings were mailed a second survey. All correspondence included a toll-free number
that members could use to contact TMG with questions regarding the survey or to
complete the survey over the telephone. Each information letter contained a statement
written in Spanish asking the member to call the toll-free number to take the survey by
phone with a Spanish interpreter. If needed, follow-up calls were then initiated with
bilingual interviewers.
TMG developed a database to track the status of members selected for the sample
at each stage of the survey protocol. The database identified members who had not
returned the survey and needed additional mailings. The database also indicated the date
that a member responded to the survey, refused to participate in the survey or was
determined to be ineligible for the survey. Members were determined to be ineligible for
the survey if they no longer qualified for SoonerCare or had moved to another state.
Data Coding and Data Entry
TMG recorded the responses to the questionnaires in a database specifically
designed for this purpose. The data entry program permitted the entry of only those
responses that were within the accepted range for each specific item; for example, if a
rating was supposed to be on a scale of 0 to 10, a response of 12 could not be entered.
TMG performed a data clean-up process prior to the actual analysis to detect any
additional out-of-range values and response inconsistencies. Typically, inconsistencies
occurred when respondents did not follow the skip pattern of question groups. When
feasible, TMG recoded the items to conform to the questionnaire skip patterns; for
example, if one response indicated the person did not receive forms to fill out, then it
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 6
would not make sense for the person to answer the next question about the ease of
completing the forms. However, when the intent of the respondent could not be
determined, the analyst recoded the item as missing.
Data Analysis
All analyses and calculations in the study were performed by APS using SAS 9.2,
including the standard CAHPS analysis macro “cc250_cahps36b.sas.” Frequencies were
computed for all the items on the survey. Due to the lengthy results for this type of
analysis, the frequency distributions are reported in Appendix B rather than in the results
section.
The statistical analysis consisted of comparing this year’s survey results with
those from the previous administration of the survey, which was in state fiscal year (SFY)
2008, using the t-test statistic for difference of means as incorporated in the standard
CAHPS analysis macro.
Global ratings, which used a scale of 0 to 10, measured the respondents’
assessment of their health plan and the quality of the care received. APS computed the
means for each global rating and used a t-test to compare means from the SFY 2008 and
SFY 2010 SoonerCare Choice surveys. Four global ratings were compared between SFY
2010 and SFY 2008:
• Overall Rating of Health Care
• Overall Rating of Personal Doctor
• Overall Rating of Specialist
• Overall Rating of Health Plan
Composite measures combine the responses to questions that are closely related to
each other and provide more reliable results than comparing each item separately. APS
computed the mean scores for each composite and used t-tests to compare means from
the SFY 2008 and SFY 2010 SoonerCare Choice surveys. The four composites that
could be compared were:
• Experiences in Getting Treatment Quickly
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 7
• Experiences with How Well Clinicians Communicate
• Experience with Getting Needed Care
• Experience with Information and Customer Service
Results
Table 1 shows the response rate by method for the current year’s survey and the
previous administration of the survey from SFY 2008.
Table 1. Completed Surveys Rate by Method each Survey by Year
Completed Surveys SFY 2010 Survey SFY 2008 Survey
Mailing 520 238
Phone Follow-Up 108 95
Total Completed Surveys 628 333
The study evaluated each returned questionnaire to determine whether it met the CAHPS
definition for a completed survey. To be considered complete, a questionnaire must have
had at least one answered question. APS coded returned questionnaires that did not pass
the completion criteria as non-respondents and excluded them from the analysis.
Additionally, returned surveys received by TMG included refusals returned by mail and
those from SoonerCare Choice members who had moved out of state or were not in the
plan.
The adjusted response rate, expressed as a percentage, is the number of completed
surveys divided by the number of eligible surveys.
Number of completed surveys
Number of eligible surveys
x 100 =
Adjusted
response rate
(total completes) 628
(Sample) –(Ineligible)
=
1688 – 106
x 100 = 39.7%
The adjusted response rates for the current (SFY 2010) SoonerCare Choice survey was
39.7%; the adjusted response rates for the previous (SFY 2008) SoonerCare Choice
survey was 21.0%. The difference in response rates may be attributable to the decision in
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 8
SFY 2010 to limit the sampling frame to participants who had a paid claim during the
sample timeframe.
Table 2 displays the disposition of surveys deemed ineligible by number and
percentage for SFY 2010.
Table 2. Number and Percentage of Ineligible Surveys for SFY 2010
Ineligible Disposition N %
Deceased 3 0.18
Mentally/Physically Incapacitated 14 0.83
Does Not Meet Criteria 89 5.27
Total Ineligibles 106 6.28
The most frequent reason for exclusion was that the survey did not contain at least one
answered question.
Demographics
Respondents were asked their race and ethnicity. Figure 1 shows these results.
Figure 1. Respondent’s Reported Racial Identity
African
American
13.5%
Caucasian
65.6%
Native
American
8.0%
Multiracial /
Other
13.0%
Caucasians represented the majority of respondents with 65.6%. Members who were
African American or multiracial/other were nearly equally represented at 13.5% and
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 9
13%, respectively. In response to a separate question about ethnicity, 5.5% of the
respondents reported to be Hispanic or Latino.
Global Ratings
In Figures 2 through 5, the overall ratings are shown for the following:
• The adult’s health care received
• The adult’s personal doctor
• The adult’s specialist
• The adult’s health plan
The means for the global rating items for the two years are shown in bar graphs.
The table below each graph lists the number of respondents analyzed, the means and the
p-value associated with the t-test of mean difference between the two years. A p-value
less than .05 was considered statistically significant. That is, if the p-value was less than
.05 the two means were statistically different from each other; otherwise, the two means
were not statistically different.*
* A statistical note: The standard CAHPS analysis does not assume equal variances, but it did not compute
a difference between the OHCA results for SFY 2008 and SFY 2010. APS used SAS PROC TTEST to
compute the significance of difference between years. Reported p-values are from pooled tests with equal
variances assumed. Only one question failed a test of equal variances, but the decision on the hypothesis
test of equal means would have been the same with a t-test that did not assume equal variances.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 10
Overall Rating of Health Care Received
• Using any number from 0 to 10, where 0 is the worst health care possible and 10
is the best health care possible, what number would you use to rate all your
health care in the last 6 months?
Figure 2. Rating of Health Care Received
7.58
7.66
0 1 2 3 4 5 6 7 8 9 10
2008
2010
Mean
Year N Mean p-value
2010 495 7.66
2008 251 7.58
.6631
Figure 2 demonstrates that SoonerCare Choice members remained fairly satisfied with
the health care they received in 2010 compared with the ratings in 2008. The slight
increase was not statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 11
Overall Rating for Personal Doctor
• Using any number from 0 to 10, where 0 is the worst personal doctor possible and
10 is the best personal doctor possible, what number would you use to rate your
personal doctor in the last 6 months?
Figure 3. Overall Rating for Personal Doctor
7.74
8.08
0 1 2 3 4 5 6 7 8 9 10
2008
2010
Mean
Year N Mean p-value
2010 496 8.08
2008 249 7.74
.0833
Figure 3 shows that SoonerCare Choice members were highly satisfied with their
personal doctor in 2010. The slight increase in satisfaction from 2008 to 2010 was not
statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 12
Overall Rating for Specialist
• We want to know your rating of the specialist you saw most often in the last 6
months. Using any number from 0 to 10, where 0 is the worst specialist possible
and 10 is the best specialist possible, what number would you use to rate that
specialist?
Figure 4. Overall Rating for Specialist
8.00
8.39
0 1 2 3 4 5 6 7 8 9 10
2008
2010
Mean
Year N Mean p-value
2010 247 8.39
2008 112 8.00
.1468
Figure 4 shows that SoonerCare Choice members were highly satisfied with their
specialist doctor seen most often in 2010. The slight increase from 2008 to 2010 was not
statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 13
Overall Rating for Health Plan
• Using any number from 0 to 10, where 0 is the worst health plan possible and 10
is the best health plan possible, what number would you use to rate your health
plan?
Figure 5. Overall Rating for Health Plan
7.59
7.82
0 1 2 3 4 5 6 7 8 9 10
2008
2010
Mean
Year N Mean p-value
2010 569 7.82
2008 306 7.59
.1718
Figure 5 shows that SoonerCare Choice members were generally satisfied with their
health plan in 2010. The increase from 2008 to 2010 was not statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 14
Composite Measures
In Figures 6 through 9, composite measures for the following services are
provided:
• Experiences in getting treatment quickly
• Experiences with how well clinicians communicate
• Experiences with getting needed treatment
• Experiences with health plan information and customer service
These questions were answered on a four-point ordinal scale, where 1= “never,” 2
= “sometimes,” 3 = “usually,” and 4 = “always.” Responses of “never” and “sometimes”
were combined into one category for the purpose of graphing since there were small
percentages in those categories. The mean of the four-point scale was computed and
compared between years using a t-test, following standard CAHPS analysis protocol.
The percentage in each category for the composite measures is shown in the bar graph.
The table below each graph lists the number of respondents analyzed, the mean and the p-value
associated with the t-test comparison of means.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 15
Getting Treatment Quickly
• In the last 6 months, when you needed care right away, how often did you get care
as soon as you thought you needed?
• In the last 6 months, not counting the times you needed care right away, how
often did you get an appointment for health care at a doctor’s office or clinic as
soon as you thought you needed?
Figure 6. Getting Treatment Quickly
22.88%
18.24%
25.12%
22.18%
52.01%
59.58%
0% 20% 40% 60% 80% 100%
2008
2010
Never/Sometimes Usually Always
Year N Mean p-value
2010 523 3.38
2008 281 3.24
.0099
Figure 6 shows that 59.58% of the respondents in 2010 reported they always received
treatment quickly. The difference of means from 2008 was statistically significant, as
52.01% of respondents in 2008 reported that they always received treatment quickly.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 16
How Well Clinicians Communicate
• In the last 6 months, how often did your personal doctor explain things in a way
that was easy to understand?
• In the last 6 months, how often did your personal doctor listen carefully to you?
• In the last 6 months, how often did your personal doctor show respect for what
you had to say?
• In the last 6 months, how often did your personal doctor spend enough time with
you?
Figure 7. How Well Clinicians Communicate
19.61%
15.78%
22.06%
21.15%
58.33%
63.06%
0% 20% 40% 60% 80% 100%
2008
2010
Never/Sometimes Usually Always
Year N Mean p-value
2010 440 3.43
2008 226 3.34
.1233
Figure 7 indicates that 63.06% of members felt that their clinicians always communicated
well during SFY 2010. This was an increase from 58.33% in SFY 2007; however, the
increase in average score was not statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 17
Getting Needed Health Care
• In the last 6 months, how often was it easy to get appointments with specialists?
• In the last 6 months, how often was it easy to get the care, tests, or treatment you
thought you needed through your health plan?
Figure 8. How Often Needed Health Care was Easy to Get
27.24%
22.18%
27.25%
27.71%
45.51%
50.11%
0% 20% 40% 60% 80% 100%
2008
2010
Never/Sometimes Usually Always
Year N Mean p-value
2010 409 3.21
2008 216 3.07
.5551
Figure 8 indicates that 50.11% of members felt that they always had easy access to
specialists and needed treatment during SFY 2010. This was an increase from 45.51% in
SFY 2008; however, the increase in average score was not statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 18
Health Plan Information and Customer Service
• In the last 6 months, how often did your health plan's customer service give you
the information or help you needed?
• In the last 6 months, how often did your health plan's customer service staff treat
you with courtesy and respect?
Figure 9. How Often Customer Service Gave Information, Courtesy, and Respect
12.06%
12.62%
22.36%
16.95%
65.58%
70.42%
0% 20% 40% 60% 80% 100%
2008
2010
Never/Sometimes Usually Always
Year N Mean p-value
2010 128 3.26
2008 90 3.25
.8897
Figure 9 indicates that 70.42% of members felt that their clinicians always communicated
well during SFY 2010. Although this was an increase from 65.58% in SFY 2008, the
increase in average score was not statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 19
Discussion
The overall picture drawn by the CAHPS data is one of high and rising
satisfaction with several different aspects of health care received from SoonerCare
providers, and also customer services provided directly by SoonerCare. Positive trends
were seen in ratings of health care, personal physicians, specialists, the health plan, and
also in composite measures of getting care quickly, provider communication, getting
needed care, and customer service. One measure increased enough to be statistically
significant: respondents reported an increase in how often they were able to get care
quickly.
The SFY 2010 sampling methodology involved limiting the sampling frame to
members who had a paid health claim. Using this method, the number of completed
surveys increased by 89% when compared to SFY 2008. The increase in completed
surveys also contributed to an adjusted response rate that was 89% higher than the
previous year. It appears to be a successful method in that members utilizing SoonerCare
services were more likely to have an opinion regarding their health care. APS
recommends the OHCA continue to follow this sampling methodology for future surveys.
Appendix A
APPENDIX A
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 22
Appendix B
Below are the responses for each survey question. There were 628 total completed
questionnaires. Frequencies depicted in the tables reflect the number of people
responding to each item; percentages depicted in the tables reflect the total number of
respondents to the particular question. Non-responses or missing data are omitted from
each table.
1. Our records show that you are now in
SoonerCare Choice. Is that right?
Q1 Frequency Percent
Yes 625 100.00
3. In the last 6 months, did you have an
illness, injury, or condition that needed care
right away in a clinic, emergency room or
doctor's office?
Q3 Frequency Percent
Yes 364 60.97
No 233 39.03
Total 597 100.00
4. In the last 6 months, when you needed
care right away how often did you get care
as soon as you thought you needed?
Q4 Frequency Percent
Never 13 3.61
Sometimes 48 13.33
Usually 81 22.50
Always 218 60.56
Total 360 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 23
5. In the last 6 months, not counting the
times you needed care right away, did you
make any appointments for your health care
at a doctor's office or clinic?
Q5 Frequency Percent
Yes 479 80.64
No 115 19.36
Total 594 100.00
6. In the last 6 months, not counting the
times you needed care right away, how often
did you get an appointment for your health
care at a doctor's office or clinic as soon as
you thought you needed?
Q6 Frequency Percent
Never 14 2.97
Sometimes 78 16.56
Usually 103 21.87
Always 276 58.60
Total 471 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 24
7. In the last 6 months, not counting times
you went to an emergency room, how many
times did you go to a doctor's office or clinic
to get care for yourself?
Q7 Frequency Percent
0 70 12.13
1 83 14.38
2 97 16.81
3 85 14.73
4 72 12.48
5 to 9 120 20.80
10 or more 50 8.67
Total 577 100.00
8. In the last 6 months, how often did you
and a doctor or other health provider talk
about specific things you could do to
prevent illness?
Q8 Frequency Percent
Never 70 14.00
Sometimes 122 24.40
Usually 126 25.20
Always 182 36.40
Total 500 100.00
9. In the last 6 months, did a doctor or other
health provider tell you there was more than
one choice for your treatment or health
care?
Q9 Frequency Percent
Yes 242 48.69
No 255 51.31
Total 497 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 25
10. In the last 6 months, did a doctor or
other health provider talk with you about
the pros and cons of each choice for your
treatment or health care?
Q10 Frequency Percent
Definitely Yes 132 55.00
Somewhat Yes 84 35.00
Somewhat No 18 7.50
Definitely No 6 2.50
Total 240 100.00
11. In the last 6 months, when there was
more than one choice for your treatment or
health care, did a doctor or other health
provider ask which choice you thought was
best for you?
Q11 Frequency Percent
Definitely Yes 119 50.00
Somewhat Yes 94 39.50
Somewhat No 12 5.04
Definitely No 13 5.46
Total 238 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 26
12. Rating of all health care
Q12 Frequency Percent
0 Worst 8 1.62
1 6 1.21
2 4 0.81
3 13 2.63
4 21 4.24
5 52 10.51
6 32 6.46
7 54 10.91
8 79 15.96
9 67 13.54
10 Best 159 32.12
Total 495 100.00
13. Do you have a personal doctor?
Q13 Frequency Percent
Yes 511 87.50
No 73 12.50
Total 584 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 27
14. In the last 6 months, how many times did
you visit your personal doctor to get care for
yourself?
Q14 Frequency Percent
0 62 12.33
1 89 17.69
2 89 17.69
3 72 14.31
4 70 13.92
5 to 9 96 19.09
10 or more 25 4.97
Total 503 100.00
15. In the last 6 months, how often did your
personal doctor explain things in a way that
was easy to understand?
Q15 Frequency Percent
Never 17 3.88
Sometimes 44 10.05
Usually 99 22.60
Always 278 63.47
Total 438 100.00
16. In the last 6 months, how often did your
personal doctor listen carefully to you?
Q16 Frequency Percent
Never 19 4.35
Sometimes 56 12.81
Usually 85 19.45
Always 277 63.39
Total 437 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 28
17. In the last 6 months, how often did your
personal doctor show respect for what you
had to say?
Q17 Frequency Percent
Never 15 3.43
Sometimes 43 9.84
Usually 82 18.76
Always 297 67.96
Total 437 100.00
18. In the last 6 months, how often did your
personal doctor spend enough time with
you?
Q18 Frequency Percent
Never 22 5.03
Sometimes 60 13.73
Usually 104 23.80
Always 251 57.44
Total 437 100.00
19. In the last 6 months, did you get care
from a doctor or other health provider
besides your personal doctor?
Q19 Frequency Percent
Yes 288 65.90
No 149 34.10
Total 437 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 29
20. In the last 6 months, how often did your
personal doctor seem informed and up-to-date
about the care you got from these
doctors or other health providers?
Q20 Frequency Percent
Never 34 12.06
Sometimes 48 17.02
Usually 73 25.89
Always 127 45.04
Total 282 100.00
21. Rating of personal doctor
Q21 Frequency Percent
0 Worst 9 1.81
1 6 1.21
2 10 2.02
3 9 1.81
4 15 3.02
5 30 6.05
6 24 4.84
7 37 7.46
8 75 15.12
9 69 13.91
10 Best 212 42.74
Total 496 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 30
22. In the last 6 months, did you try to make
any appointments to see a specialist?
Q22 Frequency Percent
Yes 275 47.66
No 302 52.34
Total 577 100.00
23. In the last 6 months, how often was it
easy to get appointments with specialists?
Q23 Frequency Percent
Never 22 8.09
Sometimes 41 15.07
Usually 72 26.47
Always 137 50.37
Total 272 100.00
24. How many specialists have you seen in
the last 6 months?
Q24 Frequency Percent
0 24 8.79
1 142 52.01
2 57 20.88
3 27 9.89
4 14 5.13
5 9 3.30
Total 273 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 31
25. Rating of specialist saw most often
Q25 Frequency Percent
0 Worst 2 0.81
1 1 0.40
2 5 2.02
3 5 2.02
4 8 3.24
5 9 3.64
6 18 7.29
7 14 5.67
8 24 9.72
9 38 15.38
10 Best 123 49.80
Total 247 100.00
26. In the last 6 months, did you try to get
any kind of care, tests, or treatment through
your health plan?
Q26 Frequency Percent
Yes 351 61.58
No 219 38.42
Total 570 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 32
27. In the last 6 months, how often was it
easy to get care, tests, or treatment you
thought you needed through your health
plan?
Q27 Frequency Percent
Never 20 5.73
Sometimes 54 15.47
Usually 101 28.94
Always 174 49.86
Total 349 100.00
28. In the last 6 months, did you look for any
information in written materials or on the
Internet about how your health plan works?
Q28 Frequency Percent
Yes 91 15.77
No 486 84.23
Total 577 100.00
29. In the last 6 months, how often did the
written materials or the Internet provide the
information you needed about how your
health plan works?
Q29 Frequency Percent
Never 4 4.49
Sometimes 22 24.72
Usually 33 37.08
Always 30 33.71
Total 89 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 33
30. In the last 6 months, did you try to get
information or help from your health plan's
customer service?
Q30 Frequency Percent
Yes 129 22.47
No 445 77.53
Total 574 100.00
31. In the last 6 months, how often did your
health plan's customer service give you the
information or help you needed?
Q31 Frequency Percent
Never 11 8.66
Sometimes 23 18.11
Usually 32 25.20
Always 61 48.03
Total 127 100.00
32. In the last 6 months, how often did your
health plan's customer service staff treat
you with courtesy and respect?
Q32 Frequency Percent
Never 9 7.20
Sometimes 12 9.60
Usually 27 21.60
Always 77 61.60
Total 125 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 34
33. In the last 6 months, did your health plan
give you any forms to fill out?
Q33 Frequency Percent
Yes 125 22.08
No 441 77.92
Total 566 100.00
34. In the last 6 months, how often were the
forms from your health plan easy to fill out?
Q34 Frequency Percent
Never 7 5.83
Sometimes 23 19.17
Usually 46 38.33
Always 44 36.67
Total 120 100.00
35. Rating of your health plan
Q35 Frequency Percent
0 Worst 10 1.76
1 5 0.88
2 9 1.58
3 5 0.88
4 20 3.51
5 47 8.26
6 42 7.38
7 65 11.42
8 101 17.75
9 68 11.95
10 Best 197 34.62
Total 569 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 35
36. In general, how would you rate your
overall health?
Q36 Frequency Percent
Excellent 38 6.55
Very Good 88 15.17
Good 172 29.66
Fair 180 31.03
Poor 102 17.59
Total 580 100.00
37. Do you now smoke cigarettes or use
tobacco every day, some days, or not at all?
Q37 Frequency Percent
Every day 191 32.76
Some days 74 12.69
Not at all 305 52.32
Don’t know 13 2.23
Total 583 100.00
38. In the last 6 months, how often were you
advised to quit smoking or using tobacco by
a doctor or other health provider in your
plan?
Q38 Frequency Percent
Never 58 22.14
Sometimes 65 24.81
Usually 48 18.32
Always 91 34.73
Total 262 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 36
39. In the last 6 months, how often was
medication recommended or discussed by a
doctor or health provider to assist you with
quitting smoking or using tobacco?
Q39 Frequency Percent
Never 127 49.22
Sometimes 64 24.81
Usually 29 11.24
Always 38 14.73
Total 258 100.00
40. In the last 6 months, how often did your
doctor or health provider discuss or provide
methods and strategies other than
medication to assist you with quitting
smoking or using tobacco?
Q40 Frequency Percent
Never 156 61.18
Sometimes 49 19.22
Usually 21 8.24
Always 29 11.37
Total 255 100.00
41. Do you take aspirin daily or every other
day?
Q41 Frequency Percent
Yes 162 28.52
No 406 71.48
Total 568 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 37
42. Do you have a health problem or take
medication that makes taking aspirin unsafe
for you?
Q42 Frequency Percent
Yes 81 16.30
No 416 83.70
Total 497 100.00
43. Has a doctor or health provider ever
discussed with you the risks and benefits of
aspirin to prevent heart attack or stroke?
Q43 Frequency Percent
Yes 237 41.22
No 338 58.78
Total 575 100.00
44. Are you aware that you have any of the
following conditions? High cholesterol
Q44A Frequency Percent
No 441 70.22
Yes 187 29.78
Total 628 100.00
44. Are you aware that you have any of the
following conditions? High blood pressure
Q44B Frequency Percent
No 374 59.55
Yes 254 40.45
Total 628 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 38
44. Are you aware that you have any of the
following conditions? Parent or sibling with
heart attack before the age of 60
Q44C Frequency Percent
No 479 76.27
Yes 149 23.73
Total 628 100.00
45. Has a doctor ever told you that you have
any of the following conditions? A heart
attack
Q45A Frequency Percent
No 577 91.88
Yes 51 8.12
Total 628 100.00
45. Has a doctor ever told you that you have
any of the following conditions? Angina or
coronary heart disease
Q45B Frequency Percent
No 577 91.88
Yes 51 8.12
Total 628 100.00
45. Has a doctor ever told you that you have
any of the following conditions? A stroke
Q45C Frequency Percent
No 578 92.04
Yes 50 7.96
Total 628 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 39
45. Has a doctor ever told you that you have
any of the following conditions? Any kind of
diabetes or high blood sugar
Q45D Frequency Percent
No 481 76.59
Yes 147 23.41
Total 628 100.00
46. In the last 6 months, have you seen a
doctor or other health provider 3 or more
times for the same condition or problem?
Q46 Frequency Percent
Yes 322 55.23
No 261 44.77
Total 583 100.00
47. Is this a condition or problem that has
lasted for at least 3 months? Do not include
pregnancy or menopause.
Q47 Frequency Percent
Yes 270 86.26
No 43 13.74
Total 313 100.00
48. Do you now need or take medicine
prescribed by a doctor? Do not include birth
control.
Q48 Frequency Percent
Yes 477 81.82
No 106 18.18
Total 583 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 40
49. Is this to treat a condition that has lasted
for at least 3 months? Do not include
pregnancy or menopause.
Q49 Frequency Percent
Yes 428 92.04
No 37 7.96
Total 465 100.00
50. What is your age?
Q50 Frequency Percent
18-24 107 18.26
25-34 73 12.46
35-44 99 16.89
45-54 169 28.84
55-64 135 23.04
65-74 3 0.51
Total 586 100.00
51. Are you male or female?
Q51 Frequency Percent
Male 187 32.13
Female 395 67.87
Total 582 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 41
52. What is the highest grade or level of
school that you have completed?
Q52 Frequency Percent
8th grade or less 44 7.61
Some high school 156 26.99
HS grad or GED 229 39.62
Some college 131 22.66
College grad 15 2.60
More than 4yr college 3 0.52
Total 578 100.00
53. Are you of Hispanic or Latino origin or
descent?
Q53 Frequency Percent
Yes 30 5.49
No 516 94.51
Total 546 100.00
54. What is your race?
Q54 Frequency Percent
White 379 65.57
Black or African
American
78 13.49
American Indian or
Alaska Native1
46 7.96
Multiracial / Other2 75 12.98
Total 578 100.00
1The race categories are based upon the standard CMS nomenclature for
all Medicaid programs.
2Respondents who selected more than one race were grouped in the
multiracial / other category.
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 42
55. Did someone help you complete this survey?
Q55 Frequency Percent
Yes 114 24.20
No 357 75.80
Total 471 100.00
56. How did that person help you? Read the
questions to me
Q56A Frequency Percent
No 47 41.23
Yes 67 58.77
Total 114 100.00
56. How did that person help you? Wrote down
the answers I gave
Q56B Frequency Percent
No 69 60.53
Yes 45 39.47
Total 114 100.00
56. How did that person help you? Answered
the questions for me
Q56C Frequency Percent
No 81 71.05
Yes 33 28.95
Total 114 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 43
56. How did that person help you? Translated
the questions into my language
Q56D Frequency Percent
No 108 94.74
Yes 6 5.26
Total 114 100.00
56. How did that person help you? Helped in
some other way
Q56E Frequency Percent
No 103 90.35
Yes 11 9.65
Total 114 100.00

Oklahoma Health Care Authority
CAHPS® Adult Health Survey
for SoonerCare Choice
Executive Summary and
Technical Specifications
Report for Fiscal Year 2010
Report Submitted May 2010
Submitted by:
APS Healthcare
4545 North Lincoln Boulevard
Suite 24
Oklahoma City, Oklahoma 73105
(405) 556-9700
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 2
CAHPS® Adult Health Survey for SoonerCare Choice
Executive Summary
The Oklahoma Health Care Authority (OHCA) is the state agency responsible
for administering Medicaid. SoonerCare Choice, the managed care component of
Oklahoma Medicaid, operated under a partially capitated case management system
during the first half of the state fiscal year (SFY) 2009. A patient-centered medical
home model was implemented January 1, 2009. In order to evaluate service
satisfaction, the OHCA contracted with APS Healthcare to survey adult members
enrolled in SoonerCare Choice between December 1, 2008, and November 30, 2009.
The OHCA has administered CAHPS (Consumer Assessment of Healthcare
Providers Systems) surveys to measure consumer satisfaction in the Medicaid
population since 1996.
Comparing the 2008 survey and the 2010 survey, results indicated fairly high
levels of satisfaction holding steady across an array of eight quality measures. The
overall picture drawn by the CAHPS data is one of high and rising satisfaction with
several different aspects of health care received from SoonerCare providers, and also
customer services provided directly by SoonerCare. Positive trends were seen in
ratings of health care, personal physicians, specialists, and the health plan, and also in
composite measures of getting care quickly, provider communication, getting needed
care, and customer service. One increase was statistically significant; respondents
gave higher ratings on how often they were able to get care quickly.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 3
CAHPS® Adult Health Survey for SoonerCare Choice
Technical Specifications
Consumer satisfaction surveys are an important source of information to
consumers, purchasers of health care, health plans and program administrators. By
responding to satisfaction surveys, individuals provide valuable information regarding
access to care, use of services, and satisfaction with the care they have received. To
survey the general population of managed care members about their overall experience
with their health plan, the Oklahoma Health Care Authority (OHCA) has administered
Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys to
SoonerCare members since 1996. CAHPS questionnaires, administration protocol and
survey analysis were developed by Harvard, RAND and the Research Triangle Institute.
The health care community has accepted these methods in producing consumer
satisfaction measures that may be compared across health plans and health service
delivery types.
In order to evaluate service satisfaction, the OHCA contracted with APS
Healthcare (APS) to survey the members enrolled in SoonerCare Choice between
December 1, 2008, and November 30, 2009. This technical report includes information
on the survey methodology, findings, and summary information on the respondents’
satisfaction with health plan services they received.
Method
The Adult CAHPS Health Plan Survey 4.0 questionnaire (shown in Appendix A)
was administered by The Myers Group (TMG) between December 16, 2009, and April 1,
2010. The questionnaire addressed several aspects of health plan performance, including:
• Rating of personal doctors, specialists, health care received, and health plan
• Receiving care without long waits
• Communication with clinicians
• Health plan information and customer service
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 4
• Getting needed care
Sampling
Because it is not feasible to survey the entire SoonerCare Choice population,
TMG used recognized sampling techniques to obtain information from a limited number
of members. This information is used to estimate the consumer satisfaction of the
SoonerCare Choice population as a whole.
Sampling for this survey followed CAHPS 4.0 protocols with one exception:
APS limited the sample to members with at least one paid claim from a SoonerCare
Choice provider. APS provided TMG with a list of eligible members for sample
selection. Each member included in the eligibility list met the following criteria:
• 18 years of age or older as of November 30, 2009;
• Enrolled in the SoonerCare Choice program as of November 30, 2009; and
• Continuously enrolled in SoonerCare Choice for 12 months between December 1,
2008, and November 30, 2009. (Continuous enrollment was defined as having no
more than one 45-day break in enrollment during the year.)
In accordance with CAHPS recommendations and to reduce the burden on
respondents, TMG randomly selected only one member from a household for the sample.
The CAHPS Survey and Reporting Kit 4.0 standards indicate that a minimum of 300
completed surveys are needed for a valid administration. The total number of members
eligible for the survey was 44,772; TMG selected a random sample of 1,688 members.
Data Collection
The CAHPS survey methodology allowed data to be collected by mail, telephone
interview, or a combination of mail and telephone. The OHCA and APS agreed to
conduct these surveys using mail and incorporated telephone interviewing only when the
targeted response rate was not received. The survey process had outreach interventions
that included mailings of the survey packet, reminder postcards and phone follow-up with
interviewers.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 5
After the sample was selected, address lists were processed using the U.S. Postal
Service’s CASS Certified ZIP + 4 Coding Software, which verified the zip code for each
address. Each packet included a questionnaire and a letter that explained the purpose and
the importance of the survey. To encourage participation, the packet also contained a
postage-paid business reply envelope. Reminder postcards served to thank individuals
who had responded to the survey and to remind others to complete their questionnaires.
Members selected for the sample who did not respond to the first survey and/or postcard
mailings were mailed a second survey. All correspondence included a toll-free number
that members could use to contact TMG with questions regarding the survey or to
complete the survey over the telephone. Each information letter contained a statement
written in Spanish asking the member to call the toll-free number to take the survey by
phone with a Spanish interpreter. If needed, follow-up calls were then initiated with
bilingual interviewers.
TMG developed a database to track the status of members selected for the sample
at each stage of the survey protocol. The database identified members who had not
returned the survey and needed additional mailings. The database also indicated the date
that a member responded to the survey, refused to participate in the survey or was
determined to be ineligible for the survey. Members were determined to be ineligible for
the survey if they no longer qualified for SoonerCare or had moved to another state.
Data Coding and Data Entry
TMG recorded the responses to the questionnaires in a database specifically
designed for this purpose. The data entry program permitted the entry of only those
responses that were within the accepted range for each specific item; for example, if a
rating was supposed to be on a scale of 0 to 10, a response of 12 could not be entered.
TMG performed a data clean-up process prior to the actual analysis to detect any
additional out-of-range values and response inconsistencies. Typically, inconsistencies
occurred when respondents did not follow the skip pattern of question groups. When
feasible, TMG recoded the items to conform to the questionnaire skip patterns; for
example, if one response indicated the person did not receive forms to fill out, then it
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 6
would not make sense for the person to answer the next question about the ease of
completing the forms. However, when the intent of the respondent could not be
determined, the analyst recoded the item as missing.
Data Analysis
All analyses and calculations in the study were performed by APS using SAS 9.2,
including the standard CAHPS analysis macro “cc250_cahps36b.sas.” Frequencies were
computed for all the items on the survey. Due to the lengthy results for this type of
analysis, the frequency distributions are reported in Appendix B rather than in the results
section.
The statistical analysis consisted of comparing this year’s survey results with
those from the previous administration of the survey, which was in state fiscal year (SFY)
2008, using the t-test statistic for difference of means as incorporated in the standard
CAHPS analysis macro.
Global ratings, which used a scale of 0 to 10, measured the respondents’
assessment of their health plan and the quality of the care received. APS computed the
means for each global rating and used a t-test to compare means from the SFY 2008 and
SFY 2010 SoonerCare Choice surveys. Four global ratings were compared between SFY
2010 and SFY 2008:
• Overall Rating of Health Care
• Overall Rating of Personal Doctor
• Overall Rating of Specialist
• Overall Rating of Health Plan
Composite measures combine the responses to questions that are closely related to
each other and provide more reliable results than comparing each item separately. APS
computed the mean scores for each composite and used t-tests to compare means from
the SFY 2008 and SFY 2010 SoonerCare Choice surveys. The four composites that
could be compared were:
• Experiences in Getting Treatment Quickly
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 7
• Experiences with How Well Clinicians Communicate
• Experience with Getting Needed Care
• Experience with Information and Customer Service
Results
Table 1 shows the response rate by method for the current year’s survey and the
previous administration of the survey from SFY 2008.
Table 1. Completed Surveys Rate by Method each Survey by Year
Completed Surveys SFY 2010 Survey SFY 2008 Survey
Mailing 520 238
Phone Follow-Up 108 95
Total Completed Surveys 628 333
The study evaluated each returned questionnaire to determine whether it met the CAHPS
definition for a completed survey. To be considered complete, a questionnaire must have
had at least one answered question. APS coded returned questionnaires that did not pass
the completion criteria as non-respondents and excluded them from the analysis.
Additionally, returned surveys received by TMG included refusals returned by mail and
those from SoonerCare Choice members who had moved out of state or were not in the
plan.
The adjusted response rate, expressed as a percentage, is the number of completed
surveys divided by the number of eligible surveys.
Number of completed surveys
Number of eligible surveys
x 100 =
Adjusted
response rate
(total completes) 628
(Sample) –(Ineligible)
=
1688 – 106
x 100 = 39.7%
The adjusted response rates for the current (SFY 2010) SoonerCare Choice survey was
39.7%; the adjusted response rates for the previous (SFY 2008) SoonerCare Choice
survey was 21.0%. The difference in response rates may be attributable to the decision in
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 8
SFY 2010 to limit the sampling frame to participants who had a paid claim during the
sample timeframe.
Table 2 displays the disposition of surveys deemed ineligible by number and
percentage for SFY 2010.
Table 2. Number and Percentage of Ineligible Surveys for SFY 2010
Ineligible Disposition N %
Deceased 3 0.18
Mentally/Physically Incapacitated 14 0.83
Does Not Meet Criteria 89 5.27
Total Ineligibles 106 6.28
The most frequent reason for exclusion was that the survey did not contain at least one
answered question.
Demographics
Respondents were asked their race and ethnicity. Figure 1 shows these results.
Figure 1. Respondent’s Reported Racial Identity
African
American
13.5%
Caucasian
65.6%
Native
American
8.0%
Multiracial /
Other
13.0%
Caucasians represented the majority of respondents with 65.6%. Members who were
African American or multiracial/other were nearly equally represented at 13.5% and
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 9
13%, respectively. In response to a separate question about ethnicity, 5.5% of the
respondents reported to be Hispanic or Latino.
Global Ratings
In Figures 2 through 5, the overall ratings are shown for the following:
• The adult’s health care received
• The adult’s personal doctor
• The adult’s specialist
• The adult’s health plan
The means for the global rating items for the two years are shown in bar graphs.
The table below each graph lists the number of respondents analyzed, the means and the
p-value associated with the t-test of mean difference between the two years. A p-value
less than .05 was considered statistically significant. That is, if the p-value was less than
.05 the two means were statistically different from each other; otherwise, the two means
were not statistically different.*
* A statistical note: The standard CAHPS analysis does not assume equal variances, but it did not compute
a difference between the OHCA results for SFY 2008 and SFY 2010. APS used SAS PROC TTEST to
compute the significance of difference between years. Reported p-values are from pooled tests with equal
variances assumed. Only one question failed a test of equal variances, but the decision on the hypothesis
test of equal means would have been the same with a t-test that did not assume equal variances.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 10
Overall Rating of Health Care Received
• Using any number from 0 to 10, where 0 is the worst health care possible and 10
is the best health care possible, what number would you use to rate all your
health care in the last 6 months?
Figure 2. Rating of Health Care Received
7.58
7.66
0 1 2 3 4 5 6 7 8 9 10
2008
2010
Mean
Year N Mean p-value
2010 495 7.66
2008 251 7.58
.6631
Figure 2 demonstrates that SoonerCare Choice members remained fairly satisfied with
the health care they received in 2010 compared with the ratings in 2008. The slight
increase was not statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 11
Overall Rating for Personal Doctor
• Using any number from 0 to 10, where 0 is the worst personal doctor possible and
10 is the best personal doctor possible, what number would you use to rate your
personal doctor in the last 6 months?
Figure 3. Overall Rating for Personal Doctor
7.74
8.08
0 1 2 3 4 5 6 7 8 9 10
2008
2010
Mean
Year N Mean p-value
2010 496 8.08
2008 249 7.74
.0833
Figure 3 shows that SoonerCare Choice members were highly satisfied with their
personal doctor in 2010. The slight increase in satisfaction from 2008 to 2010 was not
statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 12
Overall Rating for Specialist
• We want to know your rating of the specialist you saw most often in the last 6
months. Using any number from 0 to 10, where 0 is the worst specialist possible
and 10 is the best specialist possible, what number would you use to rate that
specialist?
Figure 4. Overall Rating for Specialist
8.00
8.39
0 1 2 3 4 5 6 7 8 9 10
2008
2010
Mean
Year N Mean p-value
2010 247 8.39
2008 112 8.00
.1468
Figure 4 shows that SoonerCare Choice members were highly satisfied with their
specialist doctor seen most often in 2010. The slight increase from 2008 to 2010 was not
statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 13
Overall Rating for Health Plan
• Using any number from 0 to 10, where 0 is the worst health plan possible and 10
is the best health plan possible, what number would you use to rate your health
plan?
Figure 5. Overall Rating for Health Plan
7.59
7.82
0 1 2 3 4 5 6 7 8 9 10
2008
2010
Mean
Year N Mean p-value
2010 569 7.82
2008 306 7.59
.1718
Figure 5 shows that SoonerCare Choice members were generally satisfied with their
health plan in 2010. The increase from 2008 to 2010 was not statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 14
Composite Measures
In Figures 6 through 9, composite measures for the following services are
provided:
• Experiences in getting treatment quickly
• Experiences with how well clinicians communicate
• Experiences with getting needed treatment
• Experiences with health plan information and customer service
These questions were answered on a four-point ordinal scale, where 1= “never,” 2
= “sometimes,” 3 = “usually,” and 4 = “always.” Responses of “never” and “sometimes”
were combined into one category for the purpose of graphing since there were small
percentages in those categories. The mean of the four-point scale was computed and
compared between years using a t-test, following standard CAHPS analysis protocol.
The percentage in each category for the composite measures is shown in the bar graph.
The table below each graph lists the number of respondents analyzed, the mean and the p-value
associated with the t-test comparison of means.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 15
Getting Treatment Quickly
• In the last 6 months, when you needed care right away, how often did you get care
as soon as you thought you needed?
• In the last 6 months, not counting the times you needed care right away, how
often did you get an appointment for health care at a doctor’s office or clinic as
soon as you thought you needed?
Figure 6. Getting Treatment Quickly
22.88%
18.24%
25.12%
22.18%
52.01%
59.58%
0% 20% 40% 60% 80% 100%
2008
2010
Never/Sometimes Usually Always
Year N Mean p-value
2010 523 3.38
2008 281 3.24
.0099
Figure 6 shows that 59.58% of the respondents in 2010 reported they always received
treatment quickly. The difference of means from 2008 was statistically significant, as
52.01% of respondents in 2008 reported that they always received treatment quickly.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 16
How Well Clinicians Communicate
• In the last 6 months, how often did your personal doctor explain things in a way
that was easy to understand?
• In the last 6 months, how often did your personal doctor listen carefully to you?
• In the last 6 months, how often did your personal doctor show respect for what
you had to say?
• In the last 6 months, how often did your personal doctor spend enough time with
you?
Figure 7. How Well Clinicians Communicate
19.61%
15.78%
22.06%
21.15%
58.33%
63.06%
0% 20% 40% 60% 80% 100%
2008
2010
Never/Sometimes Usually Always
Year N Mean p-value
2010 440 3.43
2008 226 3.34
.1233
Figure 7 indicates that 63.06% of members felt that their clinicians always communicated
well during SFY 2010. This was an increase from 58.33% in SFY 2007; however, the
increase in average score was not statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 17
Getting Needed Health Care
• In the last 6 months, how often was it easy to get appointments with specialists?
• In the last 6 months, how often was it easy to get the care, tests, or treatment you
thought you needed through your health plan?
Figure 8. How Often Needed Health Care was Easy to Get
27.24%
22.18%
27.25%
27.71%
45.51%
50.11%
0% 20% 40% 60% 80% 100%
2008
2010
Never/Sometimes Usually Always
Year N Mean p-value
2010 409 3.21
2008 216 3.07
.5551
Figure 8 indicates that 50.11% of members felt that they always had easy access to
specialists and needed treatment during SFY 2010. This was an increase from 45.51% in
SFY 2008; however, the increase in average score was not statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 18
Health Plan Information and Customer Service
• In the last 6 months, how often did your health plan's customer service give you
the information or help you needed?
• In the last 6 months, how often did your health plan's customer service staff treat
you with courtesy and respect?
Figure 9. How Often Customer Service Gave Information, Courtesy, and Respect
12.06%
12.62%
22.36%
16.95%
65.58%
70.42%
0% 20% 40% 60% 80% 100%
2008
2010
Never/Sometimes Usually Always
Year N Mean p-value
2010 128 3.26
2008 90 3.25
.8897
Figure 9 indicates that 70.42% of members felt that their clinicians always communicated
well during SFY 2010. Although this was an increase from 65.58% in SFY 2008, the
increase in average score was not statistically significant.
CAHPS® Adult SoonerCare Choice Survey
Fiscal Year 2010
June 2010 Page 19
Discussion
The overall picture drawn by the CAHPS data is one of high and rising
satisfaction with several different aspects of health care received from SoonerCare
providers, and also customer services provided directly by SoonerCare. Positive trends
were seen in ratings of health care, personal physicians, specialists, the health plan, and
also in composite measures of getting care quickly, provider communication, getting
needed care, and customer service. One measure increased enough to be statistically
significant: respondents reported an increase in how often they were able to get care
quickly.
The SFY 2010 sampling methodology involved limiting the sampling frame to
members who had a paid health claim. Using this method, the number of completed
surveys increased by 89% when compared to SFY 2008. The increase in completed
surveys also contributed to an adjusted response rate that was 89% higher than the
previous year. It appears to be a successful method in that members utilizing SoonerCare
services were more likely to have an opinion regarding their health care. APS
recommends the OHCA continue to follow this sampling methodology for future surveys.
Appendix A
APPENDIX A
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 22
Appendix B
Below are the responses for each survey question. There were 628 total completed
questionnaires. Frequencies depicted in the tables reflect the number of people
responding to each item; percentages depicted in the tables reflect the total number of
respondents to the particular question. Non-responses or missing data are omitted from
each table.
1. Our records show that you are now in
SoonerCare Choice. Is that right?
Q1 Frequency Percent
Yes 625 100.00
3. In the last 6 months, did you have an
illness, injury, or condition that needed care
right away in a clinic, emergency room or
doctor's office?
Q3 Frequency Percent
Yes 364 60.97
No 233 39.03
Total 597 100.00
4. In the last 6 months, when you needed
care right away how often did you get care
as soon as you thought you needed?
Q4 Frequency Percent
Never 13 3.61
Sometimes 48 13.33
Usually 81 22.50
Always 218 60.56
Total 360 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 23
5. In the last 6 months, not counting the
times you needed care right away, did you
make any appointments for your health care
at a doctor's office or clinic?
Q5 Frequency Percent
Yes 479 80.64
No 115 19.36
Total 594 100.00
6. In the last 6 months, not counting the
times you needed care right away, how often
did you get an appointment for your health
care at a doctor's office or clinic as soon as
you thought you needed?
Q6 Frequency Percent
Never 14 2.97
Sometimes 78 16.56
Usually 103 21.87
Always 276 58.60
Total 471 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 24
7. In the last 6 months, not counting times
you went to an emergency room, how many
times did you go to a doctor's office or clinic
to get care for yourself?
Q7 Frequency Percent
0 70 12.13
1 83 14.38
2 97 16.81
3 85 14.73
4 72 12.48
5 to 9 120 20.80
10 or more 50 8.67
Total 577 100.00
8. In the last 6 months, how often did you
and a doctor or other health provider talk
about specific things you could do to
prevent illness?
Q8 Frequency Percent
Never 70 14.00
Sometimes 122 24.40
Usually 126 25.20
Always 182 36.40
Total 500 100.00
9. In the last 6 months, did a doctor or other
health provider tell you there was more than
one choice for your treatment or health
care?
Q9 Frequency Percent
Yes 242 48.69
No 255 51.31
Total 497 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 25
10. In the last 6 months, did a doctor or
other health provider talk with you about
the pros and cons of each choice for your
treatment or health care?
Q10 Frequency Percent
Definitely Yes 132 55.00
Somewhat Yes 84 35.00
Somewhat No 18 7.50
Definitely No 6 2.50
Total 240 100.00
11. In the last 6 months, when there was
more than one choice for your treatment or
health care, did a doctor or other health
provider ask which choice you thought was
best for you?
Q11 Frequency Percent
Definitely Yes 119 50.00
Somewhat Yes 94 39.50
Somewhat No 12 5.04
Definitely No 13 5.46
Total 238 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 26
12. Rating of all health care
Q12 Frequency Percent
0 Worst 8 1.62
1 6 1.21
2 4 0.81
3 13 2.63
4 21 4.24
5 52 10.51
6 32 6.46
7 54 10.91
8 79 15.96
9 67 13.54
10 Best 159 32.12
Total 495 100.00
13. Do you have a personal doctor?
Q13 Frequency Percent
Yes 511 87.50
No 73 12.50
Total 584 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 27
14. In the last 6 months, how many times did
you visit your personal doctor to get care for
yourself?
Q14 Frequency Percent
0 62 12.33
1 89 17.69
2 89 17.69
3 72 14.31
4 70 13.92
5 to 9 96 19.09
10 or more 25 4.97
Total 503 100.00
15. In the last 6 months, how often did your
personal doctor explain things in a way that
was easy to understand?
Q15 Frequency Percent
Never 17 3.88
Sometimes 44 10.05
Usually 99 22.60
Always 278 63.47
Total 438 100.00
16. In the last 6 months, how often did your
personal doctor listen carefully to you?
Q16 Frequency Percent
Never 19 4.35
Sometimes 56 12.81
Usually 85 19.45
Always 277 63.39
Total 437 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 28
17. In the last 6 months, how often did your
personal doctor show respect for what you
had to say?
Q17 Frequency Percent
Never 15 3.43
Sometimes 43 9.84
Usually 82 18.76
Always 297 67.96
Total 437 100.00
18. In the last 6 months, how often did your
personal doctor spend enough time with
you?
Q18 Frequency Percent
Never 22 5.03
Sometimes 60 13.73
Usually 104 23.80
Always 251 57.44
Total 437 100.00
19. In the last 6 months, did you get care
from a doctor or other health provider
besides your personal doctor?
Q19 Frequency Percent
Yes 288 65.90
No 149 34.10
Total 437 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 29
20. In the last 6 months, how often did your
personal doctor seem informed and up-to-date
about the care you got from these
doctors or other health providers?
Q20 Frequency Percent
Never 34 12.06
Sometimes 48 17.02
Usually 73 25.89
Always 127 45.04
Total 282 100.00
21. Rating of personal doctor
Q21 Frequency Percent
0 Worst 9 1.81
1 6 1.21
2 10 2.02
3 9 1.81
4 15 3.02
5 30 6.05
6 24 4.84
7 37 7.46
8 75 15.12
9 69 13.91
10 Best 212 42.74
Total 496 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 30
22. In the last 6 months, did you try to make
any appointments to see a specialist?
Q22 Frequency Percent
Yes 275 47.66
No 302 52.34
Total 577 100.00
23. In the last 6 months, how often was it
easy to get appointments with specialists?
Q23 Frequency Percent
Never 22 8.09
Sometimes 41 15.07
Usually 72 26.47
Always 137 50.37
Total 272 100.00
24. How many specialists have you seen in
the last 6 months?
Q24 Frequency Percent
0 24 8.79
1 142 52.01
2 57 20.88
3 27 9.89
4 14 5.13
5 9 3.30
Total 273 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 31
25. Rating of specialist saw most often
Q25 Frequency Percent
0 Worst 2 0.81
1 1 0.40
2 5 2.02
3 5 2.02
4 8 3.24
5 9 3.64
6 18 7.29
7 14 5.67
8 24 9.72
9 38 15.38
10 Best 123 49.80
Total 247 100.00
26. In the last 6 months, did you try to get
any kind of care, tests, or treatment through
your health plan?
Q26 Frequency Percent
Yes 351 61.58
No 219 38.42
Total 570 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 32
27. In the last 6 months, how often was it
easy to get care, tests, or treatment you
thought you needed through your health
plan?
Q27 Frequency Percent
Never 20 5.73
Sometimes 54 15.47
Usually 101 28.94
Always 174 49.86
Total 349 100.00
28. In the last 6 months, did you look for any
information in written materials or on the
Internet about how your health plan works?
Q28 Frequency Percent
Yes 91 15.77
No 486 84.23
Total 577 100.00
29. In the last 6 months, how often did the
written materials or the Internet provide the
information you needed about how your
health plan works?
Q29 Frequency Percent
Never 4 4.49
Sometimes 22 24.72
Usually 33 37.08
Always 30 33.71
Total 89 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 33
30. In the last 6 months, did you try to get
information or help from your health plan's
customer service?
Q30 Frequency Percent
Yes 129 22.47
No 445 77.53
Total 574 100.00
31. In the last 6 months, how often did your
health plan's customer service give you the
information or help you needed?
Q31 Frequency Percent
Never 11 8.66
Sometimes 23 18.11
Usually 32 25.20
Always 61 48.03
Total 127 100.00
32. In the last 6 months, how often did your
health plan's customer service staff treat
you with courtesy and respect?
Q32 Frequency Percent
Never 9 7.20
Sometimes 12 9.60
Usually 27 21.60
Always 77 61.60
Total 125 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 34
33. In the last 6 months, did your health plan
give you any forms to fill out?
Q33 Frequency Percent
Yes 125 22.08
No 441 77.92
Total 566 100.00
34. In the last 6 months, how often were the
forms from your health plan easy to fill out?
Q34 Frequency Percent
Never 7 5.83
Sometimes 23 19.17
Usually 46 38.33
Always 44 36.67
Total 120 100.00
35. Rating of your health plan
Q35 Frequency Percent
0 Worst 10 1.76
1 5 0.88
2 9 1.58
3 5 0.88
4 20 3.51
5 47 8.26
6 42 7.38
7 65 11.42
8 101 17.75
9 68 11.95
10 Best 197 34.62
Total 569 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 35
36. In general, how would you rate your
overall health?
Q36 Frequency Percent
Excellent 38 6.55
Very Good 88 15.17
Good 172 29.66
Fair 180 31.03
Poor 102 17.59
Total 580 100.00
37. Do you now smoke cigarettes or use
tobacco every day, some days, or not at all?
Q37 Frequency Percent
Every day 191 32.76
Some days 74 12.69
Not at all 305 52.32
Don’t know 13 2.23
Total 583 100.00
38. In the last 6 months, how often were you
advised to quit smoking or using tobacco by
a doctor or other health provider in your
plan?
Q38 Frequency Percent
Never 58 22.14
Sometimes 65 24.81
Usually 48 18.32
Always 91 34.73
Total 262 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 36
39. In the last 6 months, how often was
medication recommended or discussed by a
doctor or health provider to assist you with
quitting smoking or using tobacco?
Q39 Frequency Percent
Never 127 49.22
Sometimes 64 24.81
Usually 29 11.24
Always 38 14.73
Total 258 100.00
40. In the last 6 months, how often did your
doctor or health provider discuss or provide
methods and strategies other than
medication to assist you with quitting
smoking or using tobacco?
Q40 Frequency Percent
Never 156 61.18
Sometimes 49 19.22
Usually 21 8.24
Always 29 11.37
Total 255 100.00
41. Do you take aspirin daily or every other
day?
Q41 Frequency Percent
Yes 162 28.52
No 406 71.48
Total 568 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 37
42. Do you have a health problem or take
medication that makes taking aspirin unsafe
for you?
Q42 Frequency Percent
Yes 81 16.30
No 416 83.70
Total 497 100.00
43. Has a doctor or health provider ever
discussed with you the risks and benefits of
aspirin to prevent heart attack or stroke?
Q43 Frequency Percent
Yes 237 41.22
No 338 58.78
Total 575 100.00
44. Are you aware that you have any of the
following conditions? High cholesterol
Q44A Frequency Percent
No 441 70.22
Yes 187 29.78
Total 628 100.00
44. Are you aware that you have any of the
following conditions? High blood pressure
Q44B Frequency Percent
No 374 59.55
Yes 254 40.45
Total 628 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 38
44. Are you aware that you have any of the
following conditions? Parent or sibling with
heart attack before the age of 60
Q44C Frequency Percent
No 479 76.27
Yes 149 23.73
Total 628 100.00
45. Has a doctor ever told you that you have
any of the following conditions? A heart
attack
Q45A Frequency Percent
No 577 91.88
Yes 51 8.12
Total 628 100.00
45. Has a doctor ever told you that you have
any of the following conditions? Angina or
coronary heart disease
Q45B Frequency Percent
No 577 91.88
Yes 51 8.12
Total 628 100.00
45. Has a doctor ever told you that you have
any of the following conditions? A stroke
Q45C Frequency Percent
No 578 92.04
Yes 50 7.96
Total 628 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 39
45. Has a doctor ever told you that you have
any of the following conditions? Any kind of
diabetes or high blood sugar
Q45D Frequency Percent
No 481 76.59
Yes 147 23.41
Total 628 100.00
46. In the last 6 months, have you seen a
doctor or other health provider 3 or more
times for the same condition or problem?
Q46 Frequency Percent
Yes 322 55.23
No 261 44.77
Total 583 100.00
47. Is this a condition or problem that has
lasted for at least 3 months? Do not include
pregnancy or menopause.
Q47 Frequency Percent
Yes 270 86.26
No 43 13.74
Total 313 100.00
48. Do you now need or take medicine
prescribed by a doctor? Do not include birth
control.
Q48 Frequency Percent
Yes 477 81.82
No 106 18.18
Total 583 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 40
49. Is this to treat a condition that has lasted
for at least 3 months? Do not include
pregnancy or menopause.
Q49 Frequency Percent
Yes 428 92.04
No 37 7.96
Total 465 100.00
50. What is your age?
Q50 Frequency Percent
18-24 107 18.26
25-34 73 12.46
35-44 99 16.89
45-54 169 28.84
55-64 135 23.04
65-74 3 0.51
Total 586 100.00
51. Are you male or female?
Q51 Frequency Percent
Male 187 32.13
Female 395 67.87
Total 582 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 41
52. What is the highest grade or level of
school that you have completed?
Q52 Frequency Percent
8th grade or less 44 7.61
Some high school 156 26.99
HS grad or GED 229 39.62
Some college 131 22.66
College grad 15 2.60
More than 4yr college 3 0.52
Total 578 100.00
53. Are you of Hispanic or Latino origin or
descent?
Q53 Frequency Percent
Yes 30 5.49
No 516 94.51
Total 546 100.00
54. What is your race?
Q54 Frequency Percent
White 379 65.57
Black or African
American
78 13.49
American Indian or
Alaska Native1
46 7.96
Multiracial / Other2 75 12.98
Total 578 100.00
1The race categories are based upon the standard CMS nomenclature for
all Medicaid programs.
2Respondents who selected more than one race were grouped in the
multiracial / other category.
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 42
55. Did someone help you complete this survey?
Q55 Frequency Percent
Yes 114 24.20
No 357 75.80
Total 471 100.00
56. How did that person help you? Read the
questions to me
Q56A Frequency Percent
No 47 41.23
Yes 67 58.77
Total 114 100.00
56. How did that person help you? Wrote down
the answers I gave
Q56B Frequency Percent
No 69 60.53
Yes 45 39.47
Total 114 100.00
56. How did that person help you? Answered
the questions for me
Q56C Frequency Percent
No 81 71.05
Yes 33 28.95
Total 114 100.00
CAHPS® Adult Medicaid Survey
Fiscal Year 2010
June 2010 Page 43
56. How did that person help you? Translated
the questions into my language
Q56D Frequency Percent
No 108 94.74
Yes 6 5.26
Total 114 100.00
56. How did that person help you? Helped in
some other way
Q56E Frequency Percent
No 103 90.35
Yes 11 9.65
Total 114 100.00